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Peripheral Arterial Disease patients have low vitamin D levels – meta-analysis Oct 2015

The association of circulating 25-hydroxyvitamin D concentration with peripheral arterial disease: A meta-analysis of observational studies

Atherosclerosis, Available online 14 October 2015, doi:10.1016/j.atherosclerosis.2015.10.011
Vianne Nsengiyumvaa, Malindu E. Fernandoa, Joseph V. Moxona, Smriti M. Krishnaa, Jenna Pinchbecka, Safraz M. Omera, Dylan R. Morrisa, Rhondda E. Jonesb, Corey S. Morana, Sai W. Setoc, Jonathan Golledge, MChira, d, , (Professor)

• Conflicting evidence exists on the association of vitamin D deficiency with cardiovascular disease.
• This meta-analysis showed that patients with PAD have lower circulating 25(OH)D than non-PAD controls.
• Sub-group analysis showed that this negative association was limited to patients presenting with critical limb ischaemia.
• Whether vitamin D deficiency plays a causal role in the development of severe PAD warrants further investigation.

Background and Aims: The association of vitamin D deficiency with cardiovascular disease is controversial. The present meta-analysis was performed to examine if circulating levels of 25-hydroxyvitamin D [25(OH)D] were lower in patients with peripheral artery disease (PAD) when compared to non-PAD controls.

Methods: A comprehensive database search was conducted in Web of science, Scopus, PubMed, EMBASE and The Cochrane Library to identify observational studies reporting 25(OH)D concentrations in PAD patients and non-PAD participants. Data extraction and study quality assessments were conducted independently. A random-effects model was used to meta-analyse extracted data and generate standardized mean differences (SMDs) in circulating 25(OH)D levels between PAD patients and non-PAD controls. Subgroup analyses were conducted focusing on patients presenting with intermittent claudication (IC) and critical limb ischaemia (CLI).

Results: Six case-control studies assessing 6418 individuals fulfilled the inclusion criteria. Two studies were considered to be of moderate methodological quality and four were considered to be of high quality. A meta-analysis of data from 1217 PAD patients and 5201 non-PAD participants showed that circulating 25(OH)D concentrations were lower in PAD patients compared with non-PAD participants (SMD=-0.32, 95% CI: -0.58, -0.05; P=0.02). Subgroup analyses showed that 25(OH)D levels were significantly lower among PAD patients with CLI, but not IC, when compared to non-PAD controls (SMD=-1.29, 95% CI: -1.66, -0.91; P˂0.001 and SMD=-0.01, 95% CI: -0.15, 0.13; P=0.88, respectively).

Conclusions: This meta-analysis suggests that low levels of circulating 25(OH)D are associated with PAD presence, particularly in patients presenting with CLI. These data suggest the possibility that vitamin D insufficiency may contribute to the development of more advanced PAD although this remains to be confirmed.

See also VitaminDWiki